Titanium mesh cages (TMC) in spine surgery

Abstract

The introduction of the titanium mesh cage (TMC) in spinal surgery has opened up a variety of applications that are realizable as a result of the versatility of the implant. Differing applications of TMCs in the whole spine are described in a series of 150 patients. Replacement and reinforcement of the anterior column represent the classic use of cylindrical TMCs. The TMC as a multisegmental concave support in kyphotic deformities and as a posterior interlaminar spacer or lamina replacement after wide laminectomy are additional applications. Implant subsidence, pseudarthrosis and implant loosening are the complications typically encountered with use of TMCs. The versatility of the implant permits its use in unusual surgical situations.

Fig. 1

Classic indication for TMC: reconstruction of spondylolisthesis with anterior support of the vertebral space by TMC and posterior transpedicular fixation.

Fig. 2

Subsidence of TMC: occurrence of discrete kyphotic deformity after corpectomy of L3

Fig. 3

Complication after anterior reconstruction with TMC. Failure of the TMC after reconstruction of the anterior thoracolumbar spine in fracture. Additional posterior fusion would have been able to prevent this complication

Fig. 4 a

Failed back after decompression, cage insertion and wide laminectomy. b Stabilization and solid reconstruction with anterior TMC and posterior transpedicular fixation

Fig. 5 a

Metastasis of a prostate cancer with osteolysis of the left lateral mass of the atlas. Severe neck pain. b and c Postoperative X-rays after reconstruction of the lateral mass of the atlas and occipito-cervical fixation. The patient was pain-free until he died of the cancer 19 months after the surgery

Fig. 6 a

Metastasis of mamma carcinoma with destruction of the anterior column of C2. b and c Postoperative X-rays after transoral dissection of the body of C2 and reconstruction by TMC. Additional posterior pedicular fixation C1 to C3

Fig. 7 a

Solid bony ingrowths of TMC in the cervical spine after corpectomy. The bone formation shows viable bone within the cage. b Transverse section after effective decompression in spondylotic cervical myelopathy with visible bone inside the cage

Fig. 8 a

Patient with neurofibromatosis and severe progressive cervicothoracic kyphotic deformity. b Postoperative picture with correction of the kyphotic deformity and anterior support by TMC. c X-ray of the severely deformed thoracic spine with marked kyphotic deformity. d Postoperative X-ray after anterior kyphotic support and correction and posterior fixation. e Biological fixation: the end of the titanium cage is filled with autologous bone graft. CT scans at follow-up show solid integration of bone into the cage, thus fixing it securely in place

Fig. 9

Severe kyphotic deformity due to tuberculosis in an 11-year-old child

Fig. 10

Postoperative X-ray after reduction and anterior support with TMC

Fig. 11

Reliable protection of the medulla by TMC laminoplasty

Fig. 12

Laminoplasty with TMC after wide laminectomy due to intraspinal tumor resection

Fig. 13

Intraoperative situs after TMC laminoplasty. The mesh cage not only protects the dura from trauma but also allows positioning of the bone graft continuously over the fused area, decreasing the risk of pseudarthrosis

Fig. 14

Three-point fixation in atlantoaxial stabilization: The two anteriorly situated transarticular screws and the wire fixation of the titanium mesh cage (filled with autologous bone) provide a stable segmental fixation in all three planes of the space